Textor S C, Wilson D J, Lerman A, Romero J C, Burnett J C, Wiesner R, Dickson E R, Krom R A
Division of Hypertension, Mayo Clinic, Rochester, Minnesota 55905.
Transplantation. 1992 Jul;54(1):74-80. doi: 10.1097/00007890-199207000-00013.
Patients with hepatic cirrhosis develop widespread abnormalities in kidney function and vasoactive hormones. These change rapidly after liver transplantation during immunosuppression with cyclosporine. The role of changing eicosanoid excretion and endothelin levels in regulating renal function after transplantation in humans remains uncertain. We studied 32 patients with regard to renal hemodynamics, glomerular filtration, urinary prostacyclin (6-keto-PG-F1-alpha), thromboxane (TBX2), and endothelin before and during the first four weeks after orthotopic liver transplantation. Arterial pressure rose from 106 +/- 2/61 +/- 2 to 146 +/- 4/81 +/- 2 mmHg, (P less than .001), while renal blood flow fell (686 +/- 38 to 453 +/- 24 ml/min/1.73 m2, P less than .05), as did GFR. Pretransplant excretion of 6-keto and TBX2 was above that of normal subjects and fell progressively after transplant, as did plasma renin activity and aldosterone. The 6-keto levels fell below normal after two weeks. The ratio of TBX2/6-keto remained elevated compared with normal subjects throughout the month after transplant (1.54 +/- 0.38 vs. 0.54 +/- 0.07, P less than .01). Endothelin levels rose during the first week (7.4 +/- 1.4 vs. 12.4 +/- 2.7 pg/ml, P less than .05), but fell back to baseline thereafter. These results indicate that high levels of urinary eicosanoids in patients with liver disease fall rapidly after liver transplantation during CsA immunosuppression. Unlike results in many experimental models, these data suggest that renal vasoconstriction in humans may be associated primarily with suppression in renal prostacyclin excretion rather than stimulation of thromboxane.
肝硬化患者会出现广泛的肾功能和血管活性激素异常。在肝移植后使用环孢素进行免疫抑制期间，这些异常会迅速改变。在人类移植后，类花生酸排泄和内皮素水平的变化在调节肾功能中的作用仍不确定。我们研究了32例患者在原位肝移植前及术后前四周期间的肾血流动力学、肾小球滤过、尿前列环素（6-酮-前列腺素F1-α）、血栓素（TBX2）和内皮素情况。动脉压从106±2/61±2 mmHg升至146±4/81±2 mmHg（P＜0.001），而肾血流量下降（从686±38降至453±24 ml/min/1.73 m²，P＜0.05），肾小球滤过率也下降。移植前6-酮和TBX2的排泄高于正常受试者，移植后逐渐下降，血浆肾素活性和醛固酮也是如此。两周后6-酮水平降至正常以下。移植后整个月内，与正常受试者相比，TBX2/6-酮的比值仍升高（1.54±0.38对0.54±0.07，P＜0.01）。内皮素水平在第一周升高（7.4±1.4对12.4±2.7 pg/ml，P＜0.05），但此后回落至基线水平。这些结果表明，肝病患者尿液中高水平的类花生酸在肝移植后使用环孢素免疫抑制期间迅速下降。与许多实验模型的结果不同，这些数据表明人类肾血管收缩可能主要与肾前列环素排泄受抑制有关，而非血栓素的刺激。
